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Disease Categories > Gastrointestinal Disease

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Helicobacter pylori

Previously known as Campylobacter pylori, Helicobacter pylori (H. pylori) is one of the most common bacterial pathogens in humans.

Epidemiology

Prevalence – depends on age, socioeconomic status and ethnic group
- Approximately 35% in U.S. population
- Highest prevalence – lower income, non-Caucasian population
- Lowest prevalence – middle, upper income, Caucasian population
Transmission – probably fecal-oral

Organism

H. pylori is a gram-negative, spiral-shaped, urease-positive, microaerophilic bacterium that infects the gastric epithelium
Causes chronic inflammation in most infected hosts, up to one-half of the world's population
Implicated as risk factor for gastric adenocarcinoma and gastric B-cell lymphoma

Risk Factors

Socioeconomic status – highest in lower income, non-Caucasian population
Age – lowest in young children
Ethnicity – lowest in Caucasians

Clinical Presentation

Dyspepsia
Gastritis
Abdominal pain
Peptic ulcer disease – gastric, duodenal
Cancer
- Gastric mucosa-associated lymphoid tissue lymphoma (MALT)
- Gastric cancer

Diagnosis

Invasive diagnostic tests
- Endoscopy with gastric biopsy
  - Demonstration of organisms by histology or by rapid urease activity
Noninvasive tests for initial diagnosis in all patients ≤55 years with dyspepsia
- Urea breath test using orally administered ¹⁴C- or ¹³C-labeled urea
- Stool antigen
- Serology for antibodies to H. pylori antigens
  - Per the American College of Gastroenterologists guidelines, this test should probably only be used as first-line testing if the test has been validated with high predictive value and the prevalence of H. pylori in the patient's community is not very low or very high

Treatment

Eradication of bacteria recommended in
- H. pylori related ulcers
- Gastric B-cell lymphomas
- Patients with family history of gastric cancer
Confirmation of therapeutic eradication of H. pylori
- Histologic examination of urease testing of gastric biopsy
- Breath test with ¹⁴C-labeled urea
- Stool antigen

Indications for Ordering

Tests generally appear in the order most useful for common clinical situations
Click on number for test-specific information in the ARUP Laboratory Test Directory

Test Name and Number	Recommended Use	Limitations
Helicobacter pylori Breath Test 0020646 Method: Infrared Spectrophotometric	Initial test to determine if H. pylori is causing active infection Monitor H. pylori infection in adult patient post treatment	Negative result does not rule out possibility of H. pylori infection; if clinical signs suggest H. pylori infection, retest with new sample or alternate method Known causes of false-negative results include: - Use of antimicrobials, proton pump inhibitors and bismuth preparations within 2 weeks preceding test - Administration of breath test < 4 weeks after completion of therapy to eradicate H. pylori - Premature or late collection of post-dose sample Known causes of false-positive results include: - Patient with achlorhydria - Procedures for test administration not followed correctly - Presence of other gastric spiral organisms such as Helicobacter heilmannii ¹³C and ¹⁴C breath tests are noninvasive, but expensive due to need for special equipment
Helicobacter pylori Antigen, Stool 0065147 Method: Enzyme Immunoassay	Determine whether H. pylori has been eradicated and not just temporarily suppressed, especially in adult patients with complicated, recurrent or refractory peptic ulcers; antigen testing should be performed no sooner than 1 month after all therapy stopped
Helicobacter pylori Antibodies, IgG & IgA 0050994 Method: Enzyme Immunoassay	Determine if H. pylori is causing active infection	May require repeat testing if results equivocal and clinical suspicion present
Immunohistochemistry Stain Offering arup005 Method: Immunohistochemistry	For fixed tissue samples, consultative services as well as immunohistochemical staining for H. Pylori are available

Additional Tests Available

Click on number for test-specific information in the ARUP Laboratory Test Directory

Test Name and Number	Comments
Helicobacter pylori Antibody, IgA 0050995 Method: Enzyme Immunoassay
Helicobacter pylori Antibody, IgG 0099359 Method: Enzyme Immunoassay
Helicobacter pylori Antibody, IgM 0098392 Method: Enzyme-Linked Immunosorbent Assay

Guidelines

Bourke B, Ceponis P, Chiba N, Czinn S, Ferraro R, Fischbach L, Gold B, Hyunh H, Jacobson K, Jones NL, Koletzko S, Lebel S, Moayyedi P, Ridell R, Sherman P, van Zanten S, Beck I, Best L, Boland M, Bursey F, Chaun H, Cooper G, Craig B, Creuzenet C, Critch J, Govender K, Hassall E, Kaplan A, Keelan M, Noad G, Robertson M, Smith L, Stein M, Taylor D, Walters T, Persaud R, Whitaker S, Woodland R. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation. Can J Gastroenterol. 2005;19(7):399-408. (Link to PubMed)

General References

Chey WD, Fendrick AM. Noninvasive Helicobacter pylori testing for the "test-and-treat" strategy: a decision analysis to assess the effect of past infection on test choice. Arch Intern Med. 2001;161(17):2129-2132. (Link to PubMed)

Cirak MY, Akyon Y, Megraud F. Diagnosis of Helicobacter pylori. Helicobacter. 2007;12 Suppl 1:4-9. (Link to PubMed)

Delaney BC, Moayyedi P, Forman D. Initial management strategies for dyspepsia. Cochrane Database Syst Rev. 2003;(2):CD001961. (Link to PubMed)

Dzierzanowska-Fangrat K, Lehours P, Megraud F, Dzierzanowska D. Diagnosis of Helicobacter pylori infection. Helicobacter. 2006;11 Suppl 1:6-13. (Link to PubMed)

Franceschi F, Gasbarrini A. Helicobacter pylori and extragastric diseases. Best Pract Res Clin Gastroenterol. 2007;21(2):325-334. (Link to PubMed)

Lehours P, Yilmaz O. Epidemiology of Helicobacter pylori infection. Helicobacter. 2007;12 Suppl 1:1-3. (Link to PubMed)

Louw JA. Peptic ulcer disease. Curr Opin Gastroenterol. 2006;22(6):607-611. (Link to PubMed)

Makristathis A, Hirschl AM, Lehours P, Megraud F. Diagnosis of Helicobacter pylori infection. Helicobacter. 2004;9 Suppl 1:7-14. (Link to PubMed)

O'Brien SJ, Halder SL. GI Epidemiology: infection epidemiology and acute gastrointestinal infections. Aliment Pharmacol Ther. 2007;25(6):669-674. (Link to PubMed)

Plebani M, Basso D. Non-invasive assessment of chronic liver and gastric diseases. Clin Chim Acta. 2007;381(1):39-49. (Link to PubMed)

Pritchard DM, Crabtree JE. Helicobacter pylori and gastric cancer. Curr Opin Gastroenterol. 2006;22(6):620-625. (Link to PubMed)

Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005-1012. (Link to PubMed)

Ricci C, Holton J, Vaira D. Diagnosis of Helicobacter pylori: invasive and non-invasive tests. Best Pract Res Clin Gastroenterol. 2007;21(2):299-313. (Link to PubMed)

Saad RJ, Chey WD. Breath tests for gastrointestinal disease: the real deal or just a lot of hot air?. Gastroenterology. 2007;133(6):1763-1766. (Link to PubMed)

Shah R. Dyspepsia and Helicobacter pylori. BMJ. 2007;334(7583):41-43. (Link to PubMed)

Talley NJ, Vakil NB, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology. 2005;129(5):1756-1780. (Link to PubMed)

Talley NJ. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005;129(5):1753-1755. (Link to PubMed)

Vilaichone RK, Mahachai V, Graham DY. Helicobacter pylori diagnosis and management. Gastroenterol Clin North Am. 2006;35(2):229-247. (Link to PubMed)

Reviewed by

Grenache, David G., Ph.D. Medical Director, Special Chemistry at ARUP Laboratories; Assistant Professor, Clinical Pathology, University of Utah

Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah

Petti, Cathy A., M.D. Medical Director, Infectious Diseases at ARUP Laboratories; Assistant Professor, Pathology and Medicine, University of Utah

Comprehensive Review: March 2008
Last Update: July 2008